Orthopedic Surgery Consent Form
Patient Name
Date of Birth
Date of Surgery
Surgeon's Name
Procedure
Type of Surgery
Description of Procedure
Risks and Complications
Benefits and Alternatives
Expected Benefits
Alternative Treatments
Anesthesia
Type of Anesthesia
Risks Associated with Anesthesia
Consent and Authorization
I understand the nature and purpose of the operation, the risks involved, and the alternatives available. I have had the opportunity to ask questions and have received satisfactory answers. I voluntarily consent to the orthopedic surgery as described above.
Patient/Guardian Signature
Date
Witness Name
Witness Signature
Date